Provider attitudes regarding use of an immunization information system to identify children with asthma for influenza vaccination.

OBJECTIVES: Despite longstanding national guidelines, many children with asthma do not receive annual influenza vaccinations. Information from Medicaid-administrative claims data was integrated into the Michigan Care Improvement Registry (MCIR) to prompt providers regarding influenza vaccination among children with high-risk conditions such as asthma. The attitudes of pediatric primary care providers regarding the implementation of this system were assessed. METHODS: A survey was sent in February 2006 to office-based general pediatricians (n = 300) and family physicians (n = 300) in Michigan. The survey focused on influenza vaccination during the 2005-2006 influenza season and attitudes regarding a reminder system for providers using the MCIR. RESULTS: Overall response rate was 67 percent. MCIR participation was high (91%) among respondents, and most (83%) had MCIR information available to them prior to visits with pediatric patients. Most physicians (75%) considered the MCIR high-risk indicator for influenza vaccination a feature that they would find helpful. Some respondents reported concerns that the reminder system is limited to Medicaid patients only (44%) and regarding the completeness of Medicaid data to identify children with asthma (24%). CONCLUSIONS: Physicians have a positive overall view of a statewide registry-based automated reminder system to assist in identifying children with asthma for influenza vaccination, albeit with specific areas of concern.     

Radiographic assessment of instability of the knee due to rupture of the anterior cruciate ligament. A quadriceps-contraction technique

We compared the results of a radiographic technique for the measurement of instability of the knee with those obtained with a KT-1000 arthrometer. The study was conducted on both knees of sixty patients who had a ruptured anterior-cruciate ligament in one knee, as well as in ten control subjects. The radiographic technique included the examination of a true lateral radiograph, made while the knee was in full extension and the quadriceps was maximally contracted, with a 66.7-newton downward force produced by a 6.8-kilogram weight suspended from the ankle. As demonstrated by both techniques, the maximum difference between the displacements of the right and left knees in the control subjects was 2.5 millimeters and the mean difference between the displacements in the two knees in the patients was 7.5 millimeters. In fourteen of the sixty knees in which the ligament was ruptured, the injury was acute. The forward translation of the medial side in these fourteen knees was compared with that in the forty-six knees in which the injury was chronic. The mean difference in the displacement of the medial side in the right and left knees was 3.5 millimeters in the fourteen patients who had an acute injury and 5.0 millimeters in the forty-six patients who had a chronic injury. Thirteen of the sixty patients had disruption of the posteromedial corner of the injured knee, and the translation of the medial side in these knees was significantly increased compared with that in the intact knees of the same patients.(ABSTRACT TRUNCATED AT 250 WORDS)     

Adenosine A1 receptor activation mediates suppression of (-) bicuculline methiodide-induced seizures in rat prepiriform cortex

The protective effects of a series of stable adenosine analogs against generalized seizures initiated by focal injection of bicuculline methiodide into the rat prepiriform cortex (PPC) were studied by microinjection of these compounds into this brain area. The adenosine agonists, 5'-N-(ethyl)carboxamido-adenosine (NECA), cyclohexyladenosine, cyclopentyadenosine, 2-chloroadenosine and R- and S-phenylisopropyladenosine (R- and S-PIA), protected animals against seizures in a dose-dependent, and extremely potent manner. NECA, the most potent compound evaluated, completely prevented seizures at doses greater than or equal to 6.8 pmol. In contrast, heroic doses of the A2 selective ligand, 2-phenylaminoadenosine, afforded no protection against seizures. The rank order of potency of these compounds in suppressing seizures is as follows: NECA greater than cyclohexyladenosine greater than cyclopentyladenosine greater than or equal to R-PIA greater than 2-chloroadenosine greater than S-PIA much greater than 2-phenylaminoadenosine. These data suggest that the antiseizure activity of these compounds in the PPC results from activation of A1 adenosine receptors. Quantitative autoradiographic analysis of the distribution of tritiated adenosine agonists 30 min after microinjection in the PPC reveals that [3H]NECA diffuses to a significantly greater extent than R-[3H]PIA, which may contribute to the relatively greater potency of the former compound in suppressing bicuculline methiodide-induced seizures. These results suggest that adenosine A1 receptors may participate in the normal inhibitory regulation of the PPC, a forebrain area which may play a significant role in the pathobiology of epilepsy.     

Designing the workstation: An innovative concept

Conclusions In conclusion, this team emphasizes that the technology must not get in the way of the anesthesiologist having contact with the patient. The technology should function as transparently as possible.     

Effects of race and socioeconomic status on survival of 1,332 black, hispanic, and white women with breast cancer

Background: A survival disadvantage for black women with brest cancer, which persists after controlling for stage of the disease, has been reported. This study investigates the effects of race and socioeconomic status (SES) on breast cancer survival after controlling for age, stage, histology, and type of treatment. Methods: Kaplan-Meier and Cox proportional hazards models were used to analyze the interaction between race and SES in predicting survival in a sample of 163 black, 205 Hispanic, and 964 white women with breast cancer treated at M. D. Anderson Cancer Center (1987–1991). Results: The results of univariate and multivariate analyses indicate that race was not a significant predictor of survival after adjusting for SES and other confounding factors such as demographic and disease characteristics. SES remained a significant predictor of survival after all adjustments were made. There was no evidence of differences in type of treatment by race or SES if adjustments were made for stage. Conclusions: These results suggest that institutional factors, such as access to treatment, do not explain survival differences by race or SES. Other factors associated with low SES, such as life-style and behavior, may affect survival.